Blue Cross® Metro Detroit HMO Silver Extra - 70

2018 plan year

Overview

About this plan

With this plan, you don't need to meet your deductible to use the benefits you use most. Office visits and low prescription copays start right away. Because it's an HMO plan, you choose one doctor who coordinates all your care.

Coverage level

This is a Silver 70 plan. That means it covers about 70 percent of your health care costs. Depending on your income, you may be eligible for a silver plan that covers more of your costs. Find a plan to see if you qualify.

Availability

Plan type

Metro Detroit HMO. You'll choose a primary care physician from the Metro Detroit HMO network who will refer you to other doctors in this plan's network. If you need a service that's not available in the network, your primary care physician can also refer you to hospitals and specialists in the wider HMO network. Except for emergencies or accidental injuries, you aren't covered out-of-network. What’s the difference between HMO and PPO plans?

Monthly premiums

To give you an accurate price, we'll need some information. Find a plan to get a quote.

Deductible

If you have a family plan, and one member meets the individual deductible, Blue Cross will start paying covered benefits for that member only. The remainder of the family deductible has to be met by the remaining family members before Blue Cross will start paying covered benefits for the rest of the members on the plan.

In network

Out of network

Not covered

Out-of-pocket maximum

If you have a family plan, and one member meets the individual out-of-pocket maximum, Blue Cross will start paying 100% of the approved amount for covered benefits for that member only. The remainder of the family out-of-pocket maximum has to be met by the remaining family members before Blue Cross will start paying 100% of the approved amount for covered benefits for the rest of the members on the plan.

In network

Individual: $7,350
Family: $14,700

Out of network

Not covered

Office visits

Primary care

You pay $30.

Specialist

You pay $65

Urgent care center

You pay $75.

Emergency room

You pay 20% after deductible.

Prescriptions

Copays start at $15.

Dental

This plan doesn't include dental coverage.

Vision

This plan only includes vision coverage for children.

Related documents

For even more details about this plan, see the Certificate of Coverage (PDF). Certificates are legal documents that describe the benefits of a health insurance plan. Your plan might have different benefits and limitations than those listed in this document.

In network

You pay $30.

Out of network

Not covered

Prescriptions

In-network benefits

Using an in-network pharmacy will help keep your costs as low as possible. You can get 30- or 90-day prescriptions from retail or mail-order pharmacies. You can get 60-day prescriptions from mail-order pharmacies only. Find a pharmacy.

Out-of-network benefits

This plan doesn't cover prescriptions you get at an out-of-network pharmacy.

Covered drugs

What you pay for your medication depends on whether your plan covers the drug and which cost tier it falls under. Certain drugs may need prior authorization. Look on this list to find a drug (PDF).

Tier 1 - Generic

Commonly prescribed, generic versions of brand-name medications available for the lowest copay.

30-day supply: You pay $15.

90-day supply: You pay $45.

Tier 2 - Preferred brand

Brand-name drugs not yet available as a generic.

30-day supply: You pay $50.

90-day supply: You pay $150.

Tier 3 - Nonpreferred brand

Brand-name drugs that have generic or preferred brand alternatives.

30-day supply: You pay $100.

90-day supply: You pay $300.

Tier 4 - Preferred/nonpreferred specialty

Generic and brand-name drugs used to treat complex health conditions. They usually need special handling and approval.

You pay 40% after prescription drug deductible. Specialty drugs are limited to a 30-day supply. Some specialty drugs are limited to a 15-day supply.

Dental

Not included

This plan doesn’t include dental coverage. We offer separate dental plans that cover adults and children and help pay for exams, cleanings, fillings and more. See our Blue Dental℠ plans.

Vision

For children

You pay $0. This includes one eye exam each calendar year, standard lenses and frames or contact lenses.

Children can get pediatric benefits until the end of the calendar year in which they turn 19.

For adults

This plan doesn’t include adult vision coverage. We offer a separate vision plan that helps pay for eye exams, glasses and more. We also offer dental plans that include vision coverage.

Features

Discounts

Through Blue365®, Blue Cross members can save on a variety of products and services, including:

Notes

Depending on the health care services you need, your provider might have to get approval before providing that service. Use our website to find more information and a list of services that need approval.

Estimated pricing information for various procedures by in-network providers can be obtained by calling the Customer Service number listed on the back of your BCN ID card and providing the procedure code. Your provider can also provide this information upon request.